Article

Mental health and MRI

Mental health issues affect one in five adults in the United States, with an estimated 46,600,000 adults suffering from mental illness in 2017.1 Within this category, which is referred to as any mental illness and includes all mental illness from mild to severe, there is a subset of patients who have serious mental illness. Serious mental illness includes disorders that result in functional impairment that interferes with or limits major life activities. Among the 46,600,000 adults estimated to have any mental illness in 2017, roughly 11,200,000 adults in the United States have serious mental illness.1 Some mental health issues included in this category are phobias, attention-deficit/ hyperactivity disorder, autism, eating disorders, bipolar disorder, anxiety, depression, schizophrenia and obsessive compulsive disorder.

However, some patients with mental health issues are either unaware that they may have a disorder or they do not inform their physician about their concerns. In these cases, it can be difficult to treat. Physicians may also have issues diagnosing patients with mental health issues, such as autism, when they are young. Parents may not notice it themselves, however may hear about suspicions of mental health issues from their child's teachers or other parents. .

What are some prevalent mental disorders?

  • Anxiety affects about 42 million American adults and roughly half of the people with depression are also diagnosed with anxiety.2,3 Patients with an anxiety disorder often have intense, excessive and persistent worry about everyday situations.3 Some patients with anxiety may have panic attacks, which are episodes of sudden, intense feelings of anxiety and fear that surmount within minutes. Some examples of anxiety disorders include social anxiety disorder, phobias and separation anxiety disorder. Treatment can help with anxiety, whether that treatment is for anxiety or a medical condition that may cause anxiety.
  • Autism spectrum disorders (ASDs) were diagnosed in roughly 1 in 59 children in 2018.4,5 Boys are four times more likely to be diagnosed with an autism spectrum disorder.4 These disorders refer to conditions characterized by challenges with social skills, repetitive behavior, speech and nonverbal communication.5 Most autism disorders are influenced by genetic and environmental factors. Some patients with ASD may require significant support daily, while others may live entirely independently. Certain indicators of autism may appear by age two or three.
  • Bipolar disorder, formerly referred to as manic depression, is characterized by extreme mood swings that include emotional highs, described as mania or hypomania, and lows, called depression.6 This disorder affects roughly 6.1 million American adults.2 The mood swings may cause trouble with sleep, energy, activity, judgment, behavior, and thinking.6 Patients may or may not experience emotional symptoms between episodes. Bipolar disorder may be treated with medications and counseling.

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  • Depression affects roughly 16 million American adults.2 Patients with depression report a persistent feeling of sadness and loss of interest that can affect how they feel, think or behave.7 It can lead to a variety of emotional and physical problems. Depression may require a long-term treatment, and most patients feel better with medication or psychotherapy, sometimes with a combination of both.
  • Schizophrenia impacts about 2.4 million American adults.2 Patients with schizophrenia interpret reality abnormally, which can include delusions, hallucinations and disorganized thinking, which results in disorganized speech. They can also have abnormal or disorganized motor behavior. Schizophrenia can occur in teens and adults and requires lifelong treatment. Symptoms usually begin in a patient's 20s, and it is rare for children or adults over the age of 45 to develop them.

What can MRI tell us?

Magnetic resonance imaging (MRI) relies upon a super-conducting magnet to change the magnetic field inside the scanner. The patient lays with the region of interest, which in mental health cases is the head or brain, inside the scanner, and the machine monitors the changes in the protons caused by the pulse sequences. Certain techniques can be used during an MRI scan to highlight the brain, including fMRI and diffusion imaging. fMRI can showcase the areas of the brain that are activated by certain thoughts or activities by monitoring the blood flow. Diffusion imaging, both diffusion weighted and diffusion tensor imaging can be used to visualize the white and gray matter structures in the brain.

For years, scientists and physicians have known that the brain of someone with mental illness looks different on MRI than someone without. However, multiple disorders may appear similarly in the scans. It is possible this is because these disorders can overlap in the effects they have on patients. So, some scans can show whether there could be a mental disorder in a patient or not but has long been believed to be unable to show different disorders.

In recent years, studies have shown that there can be some differences between disorders. In the case of depression and social anxiety disorder, images may appear to have a thickening of the cortex or the principal part of the brain when compared to images taken of healthy patients.8 Autism, on the other hand, may show up on brain scans by the age of two as brain enlargement in children at a high-risk for autism spectrum diseases.9 This is possible because of the ability to image the brain structures and the thickness of tissue, which may be detailed by MRI.

Mental illnesses affect such a large portion of the American population that it may come as a relief that researchers are learning about brain tissues and the changes caused by different disorders. With the help of MRI, the field may continue to make discoveries. Hopefully, this research will result in characterization of a number of different disorders including anxiety, autism, bipolar disorder, depression and schizophrenia.

References

1. National Institute of Mental Health. "Mental Illness." NIMH.NIH.gov. February 2019. Web. 15 May 2019. <https://www.nimh.nih.gov/health/statistics/mental-illness.shtml>.

2. "Mental Health Facts in America." NAMI.org. May 2019. Web. 15 May 2019. <https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers>.

3. Anxiety and Depression Association of America. "Facts & Statistics." ADAA.org. Web. 15 May 2019. <https://adaa.org/about-adaa/press-room/facts-statistics>.

4. Mayo Clinic Staff. "Anxiety disorders." MayoClinic.org. 4 May 2018. Web. 15 May 2019. <https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961>.

5. "Autism Facts and Figures." autismspeaks.org. Web. 15 May 2019. <https://www.autismspeaks.org/autism-facts-and-figures>.

6. "What is Autism?" autismspeaks.org. Web. 15 May 2019. <https://www.autismspeaks.org/what-autism>.

7. Mayo Clinic Staff. "Depression (major depressive disorder)." MayoClinic.org. 3 February 2018. Web. 15 May 2019. <https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007>.

8. Radiological Society of North America. "MRI uncovers brain abnormalities in people with depression, anxiety." sciencedaily.com. 20 November 2017. Web. 15 May 2019. <https://www.sciencedaily.com/releases/2017/11/171120085448.htm>.

9. Heather Cody Hazlett, et al. "Early brain development in infants at high risk for autism spectrum disorder." Nature. 16 February 2017; 542: 348-351. Web. 15 May 2019. <https://www.nature.com/articles/nature21369>.